脑灰质及白质体积介导无卒中老年人左心室射血分数与认知损害的关系:一项横断面回顾性研究

doi:10.3969/j.issn.1003-9198.2026.06.009

摘要/Abstract

摘要： 目的探究无卒中老年人LVEF与脑结构及认知损害的关联。方法回顾性纳入例行健康体检的389例非卒中老年人,根据MMSE评分分为认知障碍组(n=138)与非认知障碍组(n=251),采用CAT12工具箱进行全脑形态学分析。在校正相关混杂因素后,采用限制性立方样条(RCS)分析LVEF与认知障碍之间潜在的非线性关系,通过logistic回归量化两者的独立关联,并利用中介效应分析评估灰质体积(gray matter volume, GMV)及白质体积(white matter volume, WMV)的中介作用。结果 RCS分析显示,LVEF与WMV,以及认知评分与WMV之间存在非线性关联,其余变量间均为线性关系。多因素logistic回归分析显示,LVEF(OR=0.951,95%CI: 0.915～0.989,P=0.012)、GMV(OR=0.989,95%CI: 0.983～0.995, P<0.001)、WMV(OR=0.991,95%CI: 0.986～0.996, P=0.001)、皮质厚度(OR=0.121,95%CI: 0.019～0.760,P=0.024)、脑白质高信号体积(OR=1.051,95%CI: 1.010～1.094, P=0.014)与认知障碍风险相关。中介分析表明,GMV(中介占比16.8%)与WMV(LVEF<60%时显著,占比17.92%)部分中介了LVEF与认知障碍的关联。结论在无卒中老年人中,LVEF降低与认知损害显著相关,脑结构改变在其中发挥部分中介作用。

关键词: 认知功能, 左心室射血分数, 脑容量, 无卒中老年人, 中介分析

Abstract: Objective To explore the association between left ventricular ejection fraction (LVEF) and brain structure as well as cognitive impairment in stroke-free older adults. Methods A total of 389 stroke-free older adults undergoing health examinations were retrospectively enrolled. Participants were divided into cognitive impairment group (n=138) and non-cognitive impairment group (n=251) based on their Mini-Mental State Examination (MMSE) scores. Whole-brain morphological analysis was conducted utilizing the Computational Anatomy Toolbox 12 (CAT12). After adjusting for relevant confounding factors, restricted cubic splines (RCS) were used to examine the potential nonlinear relationship between LVEF and cognitive impairment. Binary logistic regression was then employed to quantify their independent association, and mediation analysis was conducted to assess the mediating roles of gray matter volume (GMV) and white matter volume (WMV). Results RCS analysis revealed nonlinear associations between LVEF and WMV, and between cognitive scores and WMV, with linear relationships observed for all other variables. Logistic regression analysis indicated that LVEF (OR=0.951, 95%CI: 0.915－0.989, P=0.012), GMV (OR=0.989, 95%CI: 0.983－0.995, P<0.001), WMV (OR=0.991, 95%CI: 0.986－0.996, P=0.001), cortical thickness (OR=0.121, 95%CI: 0.019－0.760, P=0.024) and white matter hyperintensity volume (WMHV) (OR=1.051, 95%CI: 1.010－1.094, P=0.014) were associated with the risk of cognitive impairment. Mediation analysis showed that GMV (accounting for 16.8%) and WMV (significant only when LVEF<60%, accounting for 17.92%) partially mediated the association between LVEF and cognitive impairment. Conclusions In stroke-free older adults, reduced LVEF is significantly associated with cognitive impairment, and brain structural changes play a partial mediating role in this association.

Key words: cognitive function, left ventricular ejection fraction, brain volume, stroke-free older adults, mediation analysis

中图分类号:

R 749

谈福云, 王艳琴, 陆小伟. 脑灰质及白质体积介导无卒中老年人左心室射血分数与认知损害的关系:一项横断面回顾性研究[J]. 实用老年医学, 2026, 40(6): 585-590.

TAN Fuyun, WANG Yanqin, LU Xiaowei. Gray and white matter volumes mediate the relationship between left ventricular ejection fraction and cognitive impairment in stroke-free older adults:a cross-sectional retrospective study[J]. Practical Geriatrics, 2026, 40(6): 585-590.

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